Envenomation - Complications, Symptoms, and Treatment

Introduction:

Envenomation is basically the injection of venom (refers to the poisonous secretion of an animal) into a person's body, usually by a sting or bite. Envenomation is usually rare but can be lethal in some cases. Snake bites are often treated as venomous. Envenomation can also lead to different levels of intoxication depending on factors like species, snake size, wounds, aches, punctures, or tissue destruction. It is a toxicity that requires immediate action.

What Is Envenomation?

Envenomation is the condition in which the venom is injected by the sting or the bite of the insect. It usually occurs due to exposure to toxins or poison that results from the sting or bite of animals such as a scorpion, insects, or snakes. Envenomation can lead to two types of poisoning such as localized poisoning and systemic poisoning. Localized poisoning refers to the area, whereas systemic poisoning affects the entire body. Envenomation is considered a true emergency. The principal effect of envenomation is usually seen in the kidneys, nervous system, and heart.

What Organisms Can Cause Envenomation?

The organism that can cause envenomation are as follows:

• Rattlesnake.

• Scorpion.

• Gila monster.

• Black widow spider.

• Asian giant hornet.

• Coral snake.

• Fire ant.

• Stingray.

• Box jellyfish.

• Fire coral.

• Bruising.

What Is the Mechanism of Envenomation?

Venoms are usually applied externally or to sensitive tissues like eyes and are mostly administered by the skin piercing of the victim. Snakes insert venom into the target by piercing the skin with a specialized organ called fangs. It can be further broken into four stages known as strike launch, fang erection, fang penetration, and fang withdrawal. Snakes consist of venom glands connected to subsequent fangs and ducts. Larger snakes have been shown to deliver larger quantities of venom during strikes as compared to smaller snakes. Diagnosis of envenomation is the most important step in determining the antivenom to be applied. Anti-venom treatment is designed to treat the coagulation and hemorrhaging effects that venom has on humans.

What Are Venoms?

Venoms are mixtures of toxic compounds delivered by sting or bite. It can be self-limiting as well as lethal. Snake venom is considered one of the most dangerous biological toxins.

What Is Antivenom?

Antivenom is a medication used to treat poisonous sting or bite that works by neutralizing the venom. It is also known as venom antiserum, antivenin, and antivenom immunoglobulin. It is injected either into the veins or the muscles of the person who has been stung or bitten. The first two hours after the bite of venom bite or sting are considered the best hour for injecting antivenom. The side effects of antivenom can sometimes be severe. They include shortness of breath, allergic reactions, and serum sickness. Antivenom is recommended only when there is a high level of toxicity. The majority of antivenom is delivered intravenously. The host animals of antivenom include donkeys, goats, horses, sheep, camels, and chickens. They are often preserved as freeze-dried ampoules.

What Are Complications of Antivenom?

The complications of antivenom are as follows:

• Shock.

• Coagulopathy (refers to a condition in which the ability of blood to form a clot is impaired).

• Myopathy (refers to a neuromuscular condition in which the primary symptom is the weakness of muscles due to muscle dysfunction).

• Sepsis (refers to the condition that occurs due to the body's response towards any infection).

• Persistent bleeding.

What Are the Symptoms of Envenomation?

The symptoms of envenomation are as follows:

• Nausea.

• Vomiting.

• Labored breathing.

• Blurred or double vision.

• Sweating.

• Slurred vision.

• Swelling and redness at the bite site.

• Sharp throbbing and burning pain.

• Abnormal bleeding.

• Low blood pressure.

• Weakness in muscles.

• Constant wheezing or coughing.

• Shivering.

• Blister formation.

• Increased salivation.

• Rapid heart rate.

• Muscle twitching.

• Metallic, rubber, or mint taste in the mouth.

• Loss of consciousness.

• Necrosis.

• Bruising.

• Flange mark.

• Inability to protrude the tongue or smile.

• Generalized weakness.

How to Prevent Envenomation?

• Children are most in danger of getting the bite or sting of any organism. Hence they have to be watched.

• Avoiding exploring wild gardens.

• Doors and windows should always be closed to avoid entry of any organism.

• Avoid sitting in areas where a snake might be present.

• Wear high-top boots when walking in areas with dense vegetation.

• Do not attempt to handle or capture the venomous snake.

What Are the Different Types of Envenomation?

The types of envenomation are classified as follows:

• Dry Bites: They basically occur when there is no venom deposition and with no symptoms or signs beyond a puncture wound.

• Minimal Envenomation: It is characterized by local findings such as tenderness or bruising immediately adjacent to the bite site.

• Mild Envenomation: They lack systemic findings and laboratory abnormalities, but the local damage extends several centimeters from the bite site.

• Moderate Envenomation: It may be associated with non-threatening symptoms and signs.

• Severe Envenomation: It results in extensive local damage or systemic toxicity.

How to Treat Envenomation?

Envenomation is considered a true emergency. Treatment of envenomation depends upon the species. The following methods can be done to treat envenomation:

• Rapid examination and immediate treatment are the most important steps before treatment.

• Extra time should not be spent on first aid.

• Ice, sprays, suction, hot pack, and incision are the medical treatment options.

• The bite site should be cleaned and shaved thoroughly with germicidal soap.

• Antivenom is one of the direct means of neutralizing snake venom.

• It is considered the most effective when administered in the first six hours after the bite.

• All the tight clothing and jewelry should be removed.

What Should be Avoided During the Treatment of Envenomation?

• Application of tourniquet should be avoided.

• The wounds should not be scratched.

• Do not try to suck the remaining venom from the skin.

• Alcohol should be avoided.

• NSAIDs (nonsteroidal anti-inflammatory drugs) should be avoided.

Conclusion:

Envenomation is a potentially life-threatening disease caused due to the bite of a venomous organism. It can also be caused by spraying venom into the eyes by certain species of snakes. It is one of the toxicities that require immediate action after a bite or sting from any venomous organism. The venom treatment can be done by using anti-venom therapy as early as possible.